title: [Total aortic arch replacement for severe atherosclerotic aortic aneurysms;consecutive 135 cases study].
abstract: OBJECTIVE
  We study the validity of surgical procedure for total aortic arch replacement according to the atherosclerosis in the aortic arch.
  
  
  METHODS
  From 2007 to June 2013, Consecutive 185 patients underwent total aortic arch replacement for thoracic aortic anuerysm. We studied 135 patients[96 males 72.1 year(38~89year)]except emergency operation. We assessed the atherosclerosis in the aortic arch by preoperative enhanced computed tomography (CT)scan and intraoperative epiaortic echocardiography. Based on the degree of atherosclerosis in the aortic arch, we divided into 2 groups:group 1(G1)included 97 patients with mild or moderate atherosclerosis and group 2 (G2) 38 patients with severe atherosclerosis. We used ascending aorta as arterial cannulation site in G1 and axillary artery with 8 mm graft in G2 .We compared with both groups for preoperative comorbidities and outcomes( mortality and stroke).
  
  
  RESULTS
  Three patients died in the hospital (2%). In-hospital neurological events occurred in 12 patients, including major stroke in 4 patients, minor stroke in 4 patients and asymptomatic convulsion in 4 patients, although they were transient and clear before discharge except major stroke. There were no statistically significant differences in preoperative characteristics, cardiopulmonary bypass, brain protection, mortality, and neurological events between the 2 groups. There was a statistically difference in operation time( 388.8 minutes vs 448.5 minutes, p<0.01), intensive care unit( ICU) stay( 3.1 day vs 6.5 days, p<0.05) and hospital stay( 19.2 days vs 28.0 days, p<0.05).
  
  
  CONCLUSIONS
  We selected surgical procedure for total aortic arch replacement (TAR) according to atherosclerosis in the aortic arch. Although the rate of stroke was largely acceptable, we much need to be improved in prevention of stroke.
authors.affiliation: Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamanaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishina
authors.forename: Naoki
authors.initials: N
authors.lastname: Kanemitsu
authors.forename: Keiichi
authors.initials: K
authors.lastname: Hirose
authors.forename: Akihiro
authors.initials: A
authors.lastname: Mizuno
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nakatsuka
authors.forename: Yuki
authors.initials: Y
authors.lastname: Hori
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yasumizu
authors.forename: Masashi
authors.initials: M
authors.lastname: Yada
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D050197:Atherosclerosis / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome